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HomeMy WebLinkAboutWPO201100017 Application WPO VSMP 2019-04-26 Virginia Stormwater Management Program (VSMP) Application for Albemarle County !F" Project Name: Sentara WPO Amendment ((At PO 20 (I w 17 / l v Pik 1009—y F (The name should be the same it appears on plans) Is this an amendment to an approved plan? Yes ED No 0 Is this a revision or resubmission for review? Yes ® No D W po 2.of l OOO 17 / W PO 2-001 00 0 49 County File Number: (to be provided by the County for new applications) The following are required elements of new applications[from code section 17-40/1 For revisions or amendments,please indicate which items are being amended Signatures must be provided for any submission. ® A. Signature of the Owner for each parcel: (Required with every submission or revision, NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property.I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 032A0-02-00-00100 Malloy Properties Ill LLC CIO Malloy Companies LLC t, 7 Tax Map&Parcel Print Name of Owner Signature of Ow Da e 032A0-02-00-001 AO Martha Jefferson Hospital C/O SentOHeatthcare f 'L yi41iy Tax Map&Parcel Print Name of Owner Signature of Owner ' r Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Contact Information for the Owners)to receive correspondence: Print Name Mark Fontaine-Renaud Consulting Address 8605 Westwood Center Drive, Suite 410 City Vienna State VA zip 22182 Daytime Phone(703) 404-2346 E-mail mfontaine@renaudsconsulting.net Re%iscd 07 24!l 8 Page I oil ❑ B. All Fees [Code section 17-208] For new or modified plans;Total acres proposed to be disturbed 1.83 Acres to be ITotal Fcc Fee Due with this I Fee with Transfer or disturbed I Application modification of permit Less than I $290 $145 $20 l and less than 5 $2,700 $1,350 l $200 5 and less than 10 $3,400 $1,700 �LL�_...._.. $?50 10 and less than 50 $4,500 $2,250 $300 50 and less than $6,100 $3,050 $450 100 100 and more $9,600 $4,800 I $700 T_ For(minor)amendments to an approved plan;$200 per revie Variances;$150 Mitigation Plan,$150 ❑ C. Registration Statement on the official DEQ form. ❑ D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. ❑ E. Stormwater Management Plan satisfying the requirements of code section 17-403. ❑ F. Pollution Prevention Plan satisfying the requirements of code section 17-404. O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. ❑ H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. ❑ 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings(as-builts) for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies of all plans and any supporting documents. Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Jonathan Q. Ritchie,P.E.-Bohler Engineering VA,LLC Address 28 Blackwell Park Lane,Suite 201 City Warrenton State VA Lip 20186 Daytime Phone(540) 349-4500 E-mail Iritchie©bohlereng.com *When applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WPO# Fee Amount S Date Paid By who' Receipt# Ck# B' Rc,ised 07'24'18 Page 2 of 2 Virginia Stormwater Management Program (VSMP) 7�h-' Application for Albemarle County Project Name: Sentara WPO Amendment ( k) 1- (The name should be the some as if appears on plans) Is this an amendment to an approved plan? Yes M No 0 Is this a revision or resubmission for review? Yes 0 No IN Po 10 vl o001,7 d LN rB o )-cso' 00040 County File Number:"'BDP 2�88034- (to be provide by the County/or new applications) The following are required elements of new applications ffrom code section 17-4011 For revisions or amendments,please indicate which items are being amended.Signatures must be provided for any submission. Mi A. Signature of the Owner for each parcel:(Required with every submission or revision,NOT TO BE SIGNED BY AN AGENT OR CONSULTANT) By signing this application as the owner,I hereby certify that all requirements of these plans and permits will be complied with,and I have the authority to authorize the land disturbing activities and development on the subject property.I hereby grant the County of Albemarle the right to enter upon the property as required to ensure compliance with the approved plans and permits. 032A0-02-00-00100 Malloy Properties iii LLC CIO Malloy Companies LIC 674-1 t14 I"a—/7 Tax Map&Parcel Print Name of Owner Signature o er ate 032A0-02-00-001A0 Martha Jefferson Hospital CIO SentgHealth „'„';r� - Tax Map&Parcel Print Name of Owner Signature• Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Tax Map&Parcel Print Name of Owner Signature of Owner Date Contact Information for the Ownert.si to receive correspondence: Print Name Mark Fontaine-Renaud Consulting Address 8605 Westwood Center Drive,Suite 410 City Vienna State VA zip 22182 Daytime Phone{7031 404-2346 E-mail mfontaine@renaudsconsulting.net Revised 07/24/18 Page I of 2 0 B. All Fees[Code section 17-208] For new or modified plans;Total acres proposed to be disturbed - Acres to be Toial Fee Fee Due with this Fee with Transfer or disturbed Application modification of permit Less than I S290 $145 $20 I and less than 5 $2,700 $1,350 S200 5 and less than 10 $3,400 $1,700 S250 10 and less than 50 $4,500 S2,250 S300 50 and less than S6,100 $3,050 5450 100 100 and more $9,600 $4,800 $700 For(minor)amendments to an approved plan;S200 per review Variances;$150 Mitigation Plan;$150 O C. Registration Statement on the official DEQ form. O D. Erosion and Sediment Control Plan satisfying the requirements of code section 17-402. O E. Stormwater Management Plan satisfying the requirements of code section 17-403. O F. Pollution Prevention Plan satisfying the requirements of code section 17-404. O G. Stormwater Pollution Prevention Plan satisfying the requirements of code section 17-405. O H. Mitigation Plan satisfying the requirements of code section 17-406 for any proposed disturbance of stream buffers. O 1. Requested Variations or Exceptions as provided in code sections 17-407 and 408. O J. Construction Record Drawings(as-builts)for any existing facilities in the proposal satisfying the requirements of code section 17-422. Provide 2 copies ofall plans and any supporting documents.Professional seals must have original signatures. Additional information if not provided on plans and documents: Name of a Contact Person for correspondence(usually the plan preparer,consultant or agent) Print Name Jonathan Q.Ritchie,P.E.-Bottler Engineering VA,LLC Address 28 Blackwell Park Lane,Suite 201 City Warrenton State VA Zip 20186 Daytime Phone(540) 349-4500 E-mail jritchie@bohtereng.com •when applications and plans are reviewed,but not approved,and a response to comments is not received within 6 months from the date of county comments,the application will be deemed withdrawn.Applications without valid owner's signatures will not be considered valid. FOR OFFICE USE ONLY WFO a Fee Amount S Date Paid By who? Receipt N aft By Revised 07f24f18 Page 2 of 2 BOHLER ENGINEERING 28 Blackwell Park Lane, Suite 201,Warrenton,VA 20186 Professional Engineering Services Telephone: (540)349-4500 Fax. (540)349-0321 LETTER OF TRANSMITTAL VIA: Federal Express Po Za 5�f TO: Albemarle County RE: SDP2009-00034 Department of Community Virginia Stormwater Management Plan Amendment Development — 1st Submission 401 McIntire Road Martha Jefferson Health Services Outpatient Care Charlottesville,VA 22902 Center (434)296-5832 Proffitt Road Charlottesville,VA 22911 Albemarle County ATTN: David James DATE: January 8,2019 JOB NO: V162083 WE ARE SENDING YOU ❑Shop drawings ❑Copy of letter ®Attached ❑ Prints ❑Change order COPIES JOB# DATE REVISION REVISION SHEET NO. DESCRIPTION DATE 1 V162083 12/21/18 Check#002836 Check in the amount of$200.00 made payable to Albemarle County 1 V162083 1/7/19 1-2 of 2 Virginia Stormwater Management Program Application 2 V162083 12/21/18 1 12/21/18 1-9 of 9 Virginia Stormwater Management Plan Amendment These Are Transmitted: 0 For approval ❑For your use ❑As requested ®For review and comment DApproved as submitted ❑Approved as noted ❑ Returned for corrections REMARKS: Enclosed please find the above mentioned items for the Wawa project in Charlottesville,VA. Should you have any questions or require additional information,please do not hesitate to contact this office at (540)349-4500. COPY TO: RECEIVED' SIGNE R: JAN09 2019 COMMUNITY DEVELOPMENT onathan Q. Ritchie,P.E. File 3 ` Albemarle County Community Development Department till 1 401 McIntire Road Charlottesville,VA 22902-4596 ~` Planning Application Voice (434)296-5832 Fax (434)972-4126 PARCEL/ OWNER INFORMATION IMP 032A0-02-00-001A0 Owner(s): MARTHA JEFFERSON HOSPITAL Application # WP0201 1 0001 7 PROPERTY INFORMATION Legal Description ACREAGE TRACT 2 Magisterial Dist. Rivanna Land Use Primary Office Current AFD Not in A/F District Current Zoning Primary Highway Commercial APPLICATION INFORMATION Street Address 3263 PROFFIT RD CHARLOTTESVILLE, 22911 Entered By Judy Martin Application Type Water Protection Ordinances 03/11/2011 Project Martha Jefferson Health Services Outpatient Care Center© Proffit Road Received Date 03/01/11 Received Date Final Submittal Date 03/11/11 Total Fees 300 Closing File Date Submittal Date Final Total Paid 300 Revision Number Comments Legal Ad SUB APPLICATION(s) Type Sub Applicati Comment APPLICANT/ CONTACT INFORMATION ContactType Name Address CityState Zip Phone J PhoneCell nmary Contact :;€RUMMEL.K1i P ER,;:©liotti L tor 3.801 E.MAINS. SUITE 10 0: =RIGHMDND:'V;R._ 23219 • r. I:y 8tii978 1, Owner/Applicant MARTHA JEFFERSON HOSPITAL 459 LOCUST AVENUE CHARLOTTESVILL 22902 Signature of Contractor or Authorized Agent Date 02/21/2011 12:05 4346547324 MARTHA JEFF HOSP PAGE 02/03 'valise Nese Application for Review of z .._ Erosion & Sediment Control Plan & Stormwater kii:-=» ManagementlBMA' Plan & Stream Buffer Mitigation Plan ` `� gErosion&Sediment Control Plan a Stormwater MaosgementfBMP Platt 0 Stream Buffer Mitigation Plan E&S Plan Amendment 0 SWM Plan Amendment (Previous Plan# ) (Previous Plsm#..______) ❑ E&S Plan with Variance 0 Request for Exception #of Variances 0 SWM Pin Resubmittal ❑F S Plan Resubmlttel WPO Application# WPO Application# Submit 2 copies each of applicable planslnarrative/eomputstions Project Names �,�1' • l ` Tax map and pared:y�1 Z7 s A o tag: ►"r Amount of Land Disturbance: .'t.2 _ Acres t ecatlon of property intersections,or other): ;. ` �m 4.. I . _•�_�a► ,- [ r.� ,. ..i. I.. .�..,v'.�t _: 1,tdile rlin ' + Z.O. r"ti Comet Person(Who should we oal tweite eoneeroinS this project __ . L Address Pot P M.A.+K '. ,AaAret Jrir C iCity ONICAi43<d_.Stacy ''(A Zip 22Ui Darin*,Phone ISM'I i3-r 1 Pax#eal.S2.iei<M E-mail S_r IE ...r $(C1 etaaC',� Owner of Sword 1d40.4'Z i4A .1L t ' ]r*L P.C-A Arc*A-- Maros _IN city P t4.h, n"reP i '(tV State %t J zip Darime Moe C 9 T-_ C Fax# +( gP322-1t,=A L E-mail ;,r.:rt rcti3 4 Centimeter JC_„i.b Address City,__ State Zip Deyhtme Phone(__) Fax#(_)_ E-mail Plan Prep■rar ti1�. Ih1i.P L � 1. fi F3, � , t-- �.�� ► Address Pir ,.if<( '.,ALYCE._ City P-..T• /hi.[ZvCLS —State -O. zip ?..V'J9 Daytime phone( -4 :it:ifa3 Fax# t 2-142,. gall erot're•e•- Q l V V. ACIreN Owner/Applicant Must Rend and Sign By neebte this -too es owner,I hereby certify that all requirement's of the approved Erosion Control Man,Storazwater f'i`plat,aadlor, I ,. Plait w be complied wtth mad I ha►e the aathorrttye to*raise =the land dittar btag activities and ffd 1 subject . r' gro t di a Ceaaty or A�ehaartr tte right to enter upon the property as required to snare • of „IVDate -.� dlY - r v7 I/3 65'ti— 730.6 • ', Name Daytime phone number of Signatory MR OFsTcK USE ONLY wPt]t • Pee Amount S Date - . By who? 4. . Raeeipt# Ti3✓6 Cidl , Revised September 1 ,200$ I et _02/21/2011 12:05 4346547324 MARTHA JEFF HOSP PAGE 03/03 EROSION CONTROL PLAN: (SUBMIT 2 COPIES) Land disturbing*cavity pertaining to single family dwelling unit; 1. Plan Review $150 per review (To REPAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 2 Petmdt and First Year Inspection Fees $150 (TO BE PAID PRIOR TO SCHEDULING pREcoNSTRUCTIGN CONFERENCE FOR EROSION CONTROL PERMIT) 3. Annual Permit Renewal and Inspection Fees......... $150 (To BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTL'.COMPLETION OF APPROVED PLAN REQUIREMENTS) 4. Each reinspection................»,.............................................................................. $150 (REINSPEGTION FEES ARE INVOICED TO THE LANDOWNER) Land disturbing activity pertaining to Trots-exempt agrlcaltakd land: 5_ Plan Review $150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 6. Permit and First Year Inspection Fees $150 (TO BE PAID?MR TO SCHEDULING PRECONSTRUCTION CONFERENCE FOR EROSION CONTROL PERMIT) 7. Annual Permit Renewal and Inspection Fees $150 es PI!QIDI ANNUALLY,STARTING WITH SECOND YEAR.UNTIL COMPLETION OF APPROVED PLAN NTS) S. Each rei nspectiot: $150 (REINsPECITON FESs ARE INVOICED TO THE LANDOWNER) MI other land disturbing activity: 4. Plan Review,Disturbed Area Less Than One Acre ....._......»..............................$150 per review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 10. Permit and First Year Inspection Fees,Disturbed Area Less Than One Acre................-.$200 PAID RMm TO SCHEDULING PRECONSTRUC ION CONFERENCE FOR EROSION CONTROLPERMIT) 11. Annual Permit Renewal and Inspection.Fees,Disturbed Area Less Than One Acre........$200 (TO BE PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED FLAN RENTS) l2. Plan Review,Distuubed Area One Acre or Larger $300 per review (7'O BE PAID AT TIME OF APPLICATION AND EATS SUBMITTAL THEREAFTER UNTIL APPROVAL) 13, Permit . -sret Year Inspection Fees,Disturbed Area One Acre or Larger $100/per disturbed acre (TO BE PAID PRIOR To SCHEDULING PRECONSTRUCTTON CONFERENCE FOR EROSION CONTROL PERMIT) 14. Annual Permit Renewal and inspection Fees,Disturbed Area One Acre or Larger $1001per disturbed acre (TO an PAID ANNUALLY,STARTING WITH SECOND YEAR,UNTIL COMPLETION OF APPROVED PLAN REQUIRE/Miffs) 15. Each reinspation. ...... ...............................$250 (REIN FEES ARE INVOICED TO THE LANDOWNER) 16. Amendment to Approved Plan $180/per plan review (TO BE PAID AT TIME OF APPLICATION AND EACH SUBMITTAL THEREAFTER UNTIL APPROVAL) 17. Variances $760/peT request (70 BE PAID AT TIME OF APPLICATION) is,SUBTOTAL EROSION CONTROL PLAN...».......,..............1............................5_ Revised September 15,200S Page 2 of 3 RK ( LETTER OF 801 East Main Street TRANSMITTAL Suite 1000 Richmond,VA 23219 Phone 804.782.1903 Fax 804.782.2142 Sheet: 1 of 1 Total Pages: Date: 02/23/11 To: Albemarle County Job No.: 809 030 01 Department of Community Development Zoning & Current Development Project: Martha Jefferson Health Services 401 McIntire Road OCC Proffit Road Charlottesville, VA 22902 Attention: Max Greene We are sending you: VIA: In-House Circulation ® Plans ❑Specifications ❑ Samples ❑US Mail ®Messenger( ) ❑ Shop Drawings ❑ Prints ❑ ❑ Overnight ❑ Copy of Letter ❑ Change order ❑ FAX COPIES DWG NO. DESCRIPTION 2 Sets Martha Jefferson Health Services Outpatient Care Center C Proffit Road-Final Site Plan For Erosion&Sediment Control Plan Approval 1 Application for Review of Erosion&Sediment Control Plan& Stormwater Management/BMP Plan 1 $300 Application Fee These are transmitted as checked below: ® For approval ❑Approved ❑ Please acknowledge receipt of this material ❑For your use ❑ Approved as noted ❑ Acknowledgment of receipt not required ❑As requested ❑ Disapproved ❑ For review and comment Remarks: Copy: Rummel,Klepper&Kahl,LLP Signature: JI c , Q 0 j \ Rachael T.McKinney, P.E. If enclosures are not as noted,kindly notify us at once.